Internists' and intensivists' roles in intensive care admission decisions: a qualitative study
Internists' and intensivists' roles in intensive care admission decisions: a qualitative study
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DOI：
10.1186/s12913-018-3438-6
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发表时间：
2018-08-08
影响因子：
2.8
通讯作者：
Escher, Monica
中科院分区：
文献类型：
--
作者：
Cullati, Stephane;Hudelson, Patricia;Escher, Monica
背景：重症监护病房 (ICU) 的入院决定需要内科医生和重症医生之间的合作。清晰地认识彼此的角色是良好协作的先决条件。目的是探讨内科医生和重症医生在入院决策过程中如何看待自己的角色。方法：对在瑞士一家教学医院工作的 12 名重症医生和 12 名内科医生进行单独深入访谈。采用主题法对访谈进行分析。结果：角色可分为实际角色和身份角色。内科医生和重症医生对彼此的实际角色有着相同的看法。内科医生的实际作用是：当患者病情严重时识别严重程度的迹象，在适当的时候呼叫重症监护医生，掌握患者的相关信息并确定护理目标。重症监护医师的实际作用是：评估病房的患者、提供专家建议、快速做出决定、管理进入 ICU 的通道、拥有最终决定权，有时还决定是否限制治疗。在复杂的情况下，在履行实际职责时发现的缺陷可能会造成医生之间的紧张关系。重症监护医师的身份角色包括领导者、看门人、生死决策者和支持同事医生（顾问、高级人员和助手）。这些角色可能会被认为是情感上的负担。内科医生的身份角色是领导者和合作伙伴。结论：尽管对彼此的实际角色有共同的看法，但在 ICU 入院决策的复杂情况下，内科医生和重症医生之间可能会出现紧张关系。旨在更好地了解彼此角色的沟通技巧培训和跨专业教育干预措施将改善协作。
Background: Intensive care Unit (ICU) admission decisions involve collaboration between internists and intensivists. Clear perception of each other's roles is a prerequisite for good collaboration. The objective was to explore how internists and intensivists perceive their roles during admission decisions.Methods: Individual in-depth interviews with 12 intensivists and 12 internists working at a Swiss teaching hospital. Interviews were analyzed using a thematic approach.Results: Roles could be divided into practical roles and identity roles. Internist and intensivists had the same perception of each other's practical roles. Internists' practical roles were: recognizing signs of severity when the patient becomes acutely ill, calling the intensivist at the right moment, having the relevant information about the patient and having determined the goals of care. Intensivists' practical roles were: assessing the patient on the ward, giving expert advice, making quick decisions, managing access to the ICU, having the final decision power and, sometimes, deciding whether or not to limit treatment. In complex situations, perceived flaws in performing practical roles could create tensions between the doctors. Intensivists' identity roles included those of leader, gatekeeper, life-death decision maker, and supporting colleague doctors (consultant, senior and helper). These roles could be perceived as emotionally burdensome. Internists' identity roles were those of leader and partner.Conclusions: Despite a common perception of each other's practical roles, tensions can arise between internists and intensivists in complex situations of ICU admission decisions. Training in communication skills and interprofessional education interventions aimed at a better understanding of each other roles would improve collaboration.